This is the 2020/21 edition of State of Care
The pandemic has presented health and care services with major new challenges, but many of the problems it has revealed were present before it began.
We know that many of the models of care designed before the pandemic will not meet the needs of a post-pandemic world that has an increasingly aging population living with more complex co-morbidities.
There has been learning from the pandemic that is worth building on. The appetite to operate at pace, and encourage and fund new ways of working, could now help to develop better, more coordinated care for people delivered by local services working more effectively together.
The £5.4 billion investment in health and social care announced in September 2021 is welcome – this includes £500 million across three years to support the adult social care workforce. But we are increasingly seeing social care providers struggle to attract and retain staff, and the situation is serious and deteriorating.
There must be a sharp focus on developing a clearly defined career pathway for social care staff – linked to training and supported by consistent investment that will enable employers to attract and retain the right people.
Increased stability in social care is needed because it is also the key to easing pressure on the NHS at both the front and back doors, by reducing emergency attendances and delayed discharges. This can support the development of new models for urgent and emergency care, in which people are less likely to be inappropriately funnelled towards emergency departments, and where primary care services are able to focus on those with complex co-morbidities.
The discharge to assess fund during the pandemic has improved the flow of people out of hospital and made a crucial difference to the viability of some social care providers. Continuing this funding would enable social care providers to make longer term investments to provide much-needed step-down care, and build more meaningful relationships with primary, secondary and community care services, as well with third sector organisations and with carers. In addition to a commitment to longer-term funding, there is a need for accelerated funding to be made available now to targeted areas that are particularly struggling with demand, in order to urgently increase capacity over winter.
Ensuring services work for people locally has always been the challenge for everyone involved in health and care. For those leading services now, it means increasingly thinking of themselves as leader for their area as well as their organisation.
The goal for these leaders must be to use what we have learned from the pandemic around collaboration, and with that build both a better understanding of the health and care needs of their local area – accompanied by a single, fully resourced and outcome focused plan that includes all health and care professionals and everyone else involved in health and care.
These plans are being developed and implemented in some areas – the challenge is to create an environment that ensures they happen everywhere. The role for national leaders, including CQC, is to support this work and to maintain the focus on improved outcomes for people who use services.